踝上截骨术治疗骨折继发创伤性踝关节炎的早中期疗效  

Early-to-mid-term efficacy of supramalleolar osteotomy in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture

作　　者：王学文 李恒 龚晓峰 赖良鹏 杜辉 武勇 Wang Xuewen;Li Heng;Gong Xiaofeng;Lai Liangpeng;Du Hui;Wu Yong(The Fourth School of Clinical Medicine,Peking University,Beijing 100035,China;Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]北京大学第四临床医学院,北京100035 [2]首都医科大学附属北京积水潭医院足踝外科,北京100035

出　　处：《中华创伤骨科杂志》2025年第1期39-45,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京积水潭医院院级基金(XKGG202113)。

摘　　要：目的探讨踝上截骨术(SMO)治疗踝周骨折后继发的创伤性踝关节炎中的早中期疗效。方法回顾性分析2018年3月至2023年3月首都医科大学附属北京积水潭医院足踝外科采用SMO治疗的29例陈旧性骨折继发创伤性踝关节炎患者资料。男14例,女15例;年龄39.0(25.0,49.0)岁;陈旧性骨折类型:胫腓骨下段骨折4例,踝关节骨折19例,pilon骨折6例;16例行手术治疗,13例行保守治疗。骨折至本次手术间隔时间10.0(2.0,19.5)年。采用美国足踝外科协会(AOFAS)踝-后足评分、足部功能指数(FFI)、疼痛视觉模拟评分(VAS)评估临床疗效,采用胫骨远端关节面正位(TAS)角、胫骨远端关节面侧位(TLS)角、距骨倾斜(TT)角以及改良Takakura分期的变化进行影像学分析,并与术前进行比较;记录并发症的发生情况,末次随访时进行手术满意度评价。结果29例患者均获随访,时间17.0(14.0,23.5)个月。末次随访时所有患者的AOFAS踝-后足评分[(84.2±9.6)分]、FFI[7.0(3.0,10.9)分]、疼痛VAS评分[2.0(1.0,3.0)分]、TAS角[90.84°(86.70°,92.50°)]均较术前[(68.0±16.7)分、20.9(6.1,29.1)分、5.0(2.0,8.0)分、78.63°(74.30°,85.00°)]显著改善,差异均有统计学意义(P<0.05);末次随访时所有患者的TT角、TLS角、踝关节炎分级与术前比较差异均无统计学意义(P>0.05)。切口感染不愈合1例,切口延迟愈合3例。6例踝关节炎在影像学上有进展。患者满意度:非常满意23例,比较满意4例,一般2例,总体满意度为93.1%(27/29)。结论SMO在踝周骨折后继发的创伤性踝关节炎的治疗中表现出了较好的早中期疗效,疼痛的缓解和功能的改善比较明显,患者满意度较高。ObjectiveTo evaluate the early-to-mid-term efficacy of supramalleolar osteotomy(SMO)in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture.MethodsA retrospective study was conducted to analyze the clinical data of 29 patients who had been treated for traumatic ankle arthritis secondary to old peri-ankle fracture by SMO from March 2018 to March 2023 at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital.There were 14 males and 15 females,39.0(25.0,49.0)years in age.Types of old fracture:4 lower tibiofibular fractures,19 ankle fractures,and 6 pilon fractures.Surgery was conducted for 16 cases and conservative treatment for the remaining 13 cases.The interval between the old fracture and the current surgery was 10.0(2.0,19.5)years.The clinical efficacy was evaluated using the ankle-hindfoot score of American Association of Foot and Ankle Surgery(AOFAS),foot function index(FFI),and visual analog scale(VAS)pain score.Imaging analysis was conducted and imaging comparisons were made between pre-surgery and post-surgery in terms of tibial anterior surface(TAS)angle,tibial lateral surface(TLS)angle,talar tilt(TT)angle,and changes in modified Takakura staging.Complications were recorded.Surgical satisfaction was investigated at the final follow-up.ResultsThe 29 patients were followed up for 17.0(14.0,23.5)months.The AOFAS ankle-hindfoot score[(84.2±9.6)points],FFI[7.0(3.0,10.9)points],VAS pain score[2.0(1.0,3.0)points],and TAS angle[90.84°(86.70°,92.50°)]at the final follow-up for all patients were significantly better than the pre-surgery values[(68.0±16.7)points,20.9(6.1,29.1)points,5.0(2.0,8.0)points,and 78.63°(74.30°,85.00°)](all P<0.05).At the final follow-up,the ankle arthritis grading did not show any significant change(P>0.05)and there were no significant differences in TT angle or TLS angle between pre-surgery and post-surgery(P>0.05).Incision failed to heal in 1 case,incision healing was delayed in 3 cases,and ankle arthritis progressed on imaging in 6 cases.As for pati

关 键 词：踝关节 骨折 关节炎 踝上截骨术 临床疗效 

分 类 号：R68[医药卫生—骨科学]